Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $78.28 / $269.75 / $462.56	Facility		$78.28	$269.75	$462.56
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $42.09 / $322.63 / $790.74	Facility	25	$42.09	$322.63	$790.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.98 / $126.92 / $357.41	Professional		$75.98	$126.92	$357.41
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $82.14 / $172.00 / $372.48	Professional	25	$82.14	$172.00	$372.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.50 / $94.50 / $94.50	Professional	50	$94.50	$94.50	$94.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.79 / $169.59 / $300.02	Professional		$97.79	$169.59	$300.02
CareSource Facility/Professional Facility Modifier Low / Median / High Price $91.58 / $115.97 / $138.28	Facility		$91.58	$115.97	$138.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $118.14 / $141.77 / $197.89	Professional		$118.14	$141.77	$197.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $341.52 / $399.10 / $530.42	Facility		$341.52	$399.10	$530.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.66 / $239.22 / $362.30	Professional		$92.66	$239.22	$362.30
DeanCare Facility/Professional Facility Modifier Low / Median / High Price $70.40 / $107.83 / $209.92	Facility		$70.40	$107.83	$209.92
Medica Facility/Professional Facility Modifier Low / Median / High Price $70.95 / $109.37 / $212.97	Facility		$70.95	$109.37	$212.97
Medica Facility/Professional Facility Modifier 25 Low / Median / High Price $40.00 / $40.00 / $412.39	Facility	25	$40.00	$40.00	$412.39
Medica Facility/Professional Professional Modifier Low / Median / High Price $118.67 / $274.58 / $607.94	Professional		$118.67	$274.58	$607.94
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $199.50 / $272.80 / $332.76	Professional	25	$199.50	$272.80	$332.76
Molina Facility/Professional Professional Modifier Low / Median / High Price $78.44 / $144.45 / $269.03	Professional		$78.44	$144.45	$269.03
Prevea360 Facility/Professional Facility Modifier Low / Median / High Price $70.40 / $108.35 / $209.92	Facility		$70.40	$108.35	$209.92
Quartz Facility/Professional Professional Modifier Low / Median / High Price $163.69 / $282.86 / $388.43	Professional		$163.69	$282.86	$388.43
Quartz Facility/Professional Facility Modifier Low / Median / High Price $129.72 / $183.80 / $630.00	Facility		$129.72	$183.80	$630.00
Quartz Facility/Professional Professional Modifier Low / Median / High Price $121.30 / $551.16 / $801.06	Professional		$121.30	$551.16	$801.06
Security Health Facility/Professional Professional Modifier Low / Median / High Price $132.10 / $199.31 / $265.63	Professional		$132.10	$199.31	$265.63
United Facility/Professional Professional Modifier Low / Median / High Price $101.38 / $170.21 / $288.99	Professional		$101.38	$170.21	$288.99